In Recovery the first thing we try to recognize are our symptoms when we are confronted with a distressing situation. "Symptoms" is the general umbrella term that we use to describe immediate internally experienced responses to stress. Symptoms fall into two broad categories, the first, and perhaps most troublesome are the body's preparation for conflict, including an increased heart rate, attended shortness of breath, extra perspiration, sometimes on the palms or the face, and general tenseness of the muscles and internal organs. Our thoughts usually race through simple solutions, as our mind tries to come up with an instantaneous reaction so the threat can be dealt with a as quickly as possible. In all of this our prefrontal cortex, or higher reasoning center, is taking a back seat, or if engaged at all, is being driven by our simple fears.
Unless you really are out in the woods being confronted by an angry dog, or wandering down the streets late at night and being threatened by a mugger, what you need most of all is to *not* respond right away. This is difficult and will test your patience and self-control, but there is no easy way to shut down your high alert system once it has been activated. In Recovery we say “There are no uncontrollable impulses, only impulses that we chose to not control”. Our impulses are powerful, but aside from the extremely simple impulses (like inhaling after holding your breath for a minute or more), we can almost always control complex impulses.
In the Chapter “Symptoms Must Be Attacked Where they are Weakest” from MHTWT Abraham Low summarizes Roy’s symptoms:
Roy was 35 years of age when he was first seen in the physician's office. He was married, had two children, loved his home and was well liked by friends and neighbors. His employment record was good. He had held his present position for fifteen consecutive years advancing to the rank of a foreman. All in all he had done well until three years ago when suddenly, "out of a blue sky," his right arm and right leg went numb. The numbness had come on at the moment when he entered the plant to start on the afternoon shift. It disappeared as fast as it had come lasting a few minutes only. But Roy was frightened into a senseless fear that he was headed for a stroke. Ordinarily stolid and unemotional, he was now pale, trembling, restless. His fellow workers noticed the change and drove him home. The family physician ordered Roy to stay home for a week and to rest. The following week an electrocardiogram was taken and the doctor was heard to say that something in the graph was "flat instead of round." After that Roy developed violent palpitations, headaches, dizziness, fatigue, air-hunger, difficulty of sleeping, fears of physical collapse and mental breakdown. He saw specks floating in front of his eyes and once "nearly went blind" for a couple of minutes. Some of his sensations were bizarre and intensified his fear of a mental breakdown. Looking at his hands he saw them in a yellow tinge. He felt pains which settled in narrowly confined places, in the left wrist or in the space above the right knee. His teeth began to hurt. There was a pain around the heart. He lifted his little son and instantly felt a pain around his right ear. He lay on the left side and something clicked in the right flank. The fingers of the right hand might hurt and suddenly the pain shifted to the back of the head. He felt pressure of the throat, had night sweats which roused the fear of tuberculosis, pain in the chest, difficulty of sleeping, trouble in concentration and "confusion all the time."
Fight or Flight
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| https://en.wikipedia.org/wiki/Fight-or-flight_response |
The fight-or-flight response (also called hyperarousal, or the acute stress response) is a physiological reaction that occurs in response to a perceived harmful event, attack, or threat to survival. It was first described by Walter Bradford Cannon in 1932. His theory states that animals react to threats with a general discharge of the sympathetic nervous system, preparing the animal for fighting or fleeing. More specifically, the adrenal medulla produces a hormonal cascade that results in the secretion of catecholamines, especially norepinephrine and epinephrine (adrenaline). The hormones estrogen, testosterone, and cortisol, as well as the neurotransmitters dopamine and serotonin, also affect how organisms react to stress. This response is recognized as the first stage of the general adaptation syndrome that regulates stress responses among vertebrates and other organisms.
Since the original work we have come to see that the stress response is accomplished by a variety of interacting systems that include the amygdala and other cortical systems, which results in the hypothalamus activating the sympathetic nervous system and the HPA axis.
The stress response mechanisms include the Autonomic Nervous System (ANS); a network of hypothalamic, pituitary and adrenal responses; the cardiovascular system; metabolism; and the immune system. The function of these pathways is to prepare the body for action. These pathways move physiological energy resources to the necessary organs and muscles. They create an overall shift from storing energy to using energy. In an emergency, priorities of the body move from flexibility, including past and future considerations, to focus on immediate circumstances. Your body no longer stores energy, pays attention to sexual matters, or has your immune system worry about long-term disease. Your mind focuses on threat-relevant cues and memories which become critical as they relate to the current situation.
The autonomic nervous system (ANS) is a control system that acts largely unconsciously and regulates bodily functions such as the heart rate, digestion, respiratory rate, pupillary response, urination, and sexual arousal. It keeps the heart rate and blood pressure in balance, it coordinates the body’s response to exercise and stress, and it regulates reproduction.
The second pathway is known as the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis involves cells in the hypothalamus that are released into the bloodstream and go to the pituitary gland. This causes the pituitary to release hormones that influence peripheral organs such as the adrenals as well as cells in the immune system. This system helps to convert stored fats and carbohydrates into energy sources that can be used immediately. The immune system is activated in stressful situations in anticipation of some injury. When our minds are emotionally stressed our bodies respond by expecting to be physically assaulted and are thus prepared to keep infections out of wounds.
These mechanisms are particularly sensitive to changes in the environment, and repeated stressful events can modify their functioning. Stress can influence brain processes by reducing the connections of one neuron with another, especially in the hippocampus and the frontal areas of the brain which coordinate abstract thinking and reasoning. Stress shows the opposite effect in the amygdala with the increase of neuron connections. This in turn leaves the person with more lower brain activity (emotional and impulsive) when responding to fearful situations.
In general, stress reduces our ability to think and plan while increasing our emotional response and preparing our body for action. Our mind is geared to compute life saving responses based on our past history, and rather than thinking carefully and clearly we respond impulsively with simple or obvious reactions. We feel energized because of an increased heart rate, higher blood pressure and elevated blood sugar levels. Our organs feel tense due to the additional blood flow and because of the stress associated with the flood of adrenaline and cortisol. Our whole body is prepared to react quickly and work double or triple time to deal with the threat as soon as possible; perfect for the forest or the battlefield, but not so good for the office, home, or shopping center.
In short bursts this kind of response is natural, and we are designed for it. We get into trouble when our state of anxiety lasts for hours, days, weeks or longer. Then our feeling of being energized turns to exhaustion, the constant tension in our organs, if persistent and chronic, can lead to serious long term disease.
While knowing something about the biology is interesting how does this help us? In Roy’s case, his physical symptoms created a negative and self-reinforcing feedback loop. Understanding that his symptoms are his body's response to his fear or anger and not indicative of anything else can help to allow him to ignore those symptoms and focus on his situation instead. Being aware of his high alert state can also help him to think more clearly by recognizing that he is likely to make an impulsive choice. He should slow down or stop and take a break, and make important decisions when his symptoms are reduced. It is also important to be aware that a high alert state can create a sense of unreality. In Roy's case these physical symptoms are his body's actual response to the stress, fear, anger or upset that he is experiencing; he is not simply imagining spots before his eyes, the dizzyness, fatigue, difficulties with hearing, peculiar sensations and the many other physical symptoms that he reports having are real. While the physical symptoms have a measurable cause, they are also natural and average, and do not indicate that his body is failing immediately, but that it is responding to fear, upset, anger and distress. Ultimately this fearful response is driven by Roy's thoughts, and as he starts to understand this he can change his thoughts, and with effort, he will be able to reduce his physical symptoms.
At Recovery meetings we discuss the physical sensations associated with negative emotions. These bodily responses are our first cue that we are in a precarious position and likely to react in an impulsive way to a situation. These symptoms will come and go if we let them, although if we obsess or worry about the symptoms they will intensify. While we can't immediately banish symptoms, we can recognize them. Physical symptoms of stress are driven by thoughts and ideas, and we do have control over what we think, say and do. While we cannot stop our racing heart, we can recognize when tigers are imaginary, and with this realistic knowledge we can make reasonable choices and with effort our physical symptoms will pass.
More Information
The Biology of Depression's Vicious Cycle
Does Depression have a Physical Cause?
About Recovery Hamilton
